Trachea marking

ABSTRACT

Disclosed are systems, devices, and methods for marking a main carina and a trachea of a patient, an exemplary method comprising importing slice images of a chest of the patient, generating a three-dimensional (3D) model based on the imported slice images, displaying the 3D model in a graphical user interface (GUI), locating the main carina by viewing 2D images of the 3D model in an axial orientation, marking the main carina in one of the 2D images of the 3D model, adjusting a view plane of the 3D model around a rotation axis defined by the marked location of the main carina to adjust the view plane from an axial orientation to a coronal orientation while keeping the main carina in the view plane to thereby display the entire trachea on the GUI, and marking an upper end of the trachea in one of the 2D images of the 3D model.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of and priority to U.S.Provisional Patent Application Ser. No. 62/020,253 filed on Jul. 2,2014, the entire contents of which are incorporated herein by reference.

BACKGROUND Technical Field

The present disclosure relates to the treatment of patients with lungdiseases and, more particularly, to devices, systems, and methods formarking the trachea in a three-dimensional (3D) model generated based onCT scan image data of a patient's lungs.

Discussion of Related Art

Visualization techniques related to visualizing a patient's lungs havebeen developed so as to help clinicians perform diagnoses and/orsurgeries on the patient's lungs. Visualization is especially importantfor identifying a location of a diseased region. Further, when treatingthe diseased region, additional emphasis is given to identification ofthe particular location of the diseased region so that a surgicaloperation is performed at the correct location.

In the past, scanned two-dimensional images of the lungs have been usedto aid in visualization. In order to visualize a lung from scannedtwo-dimensional images, it is important to determine whether or not anarea of the two-dimensional images is a part of the lung. Thus,detecting a starting location where a navigation procedure will begin,for example, a location of an organ or other part that is connected toor is a part of the lung, is also important for identifying the lung. Inone example, the trachea can be used as the starting location becausethe trachea has a substantially constant diameter along its length andis known to be connected to the lung.

SUMMARY

Provided in accordance with the present disclosure is a method ofmarking a main carina and a trachea of a patient.

According to an aspect of the present disclosure, the method includesimporting, into an image processing computer, slice images of a chest ofthe patient from an imaging device, generating, by a graphics processorincluded in the image processing computer, a three-dimensional (3D)model based on the imported slice images, displaying, by the imageprocessing computer, the 3D model in a graphical user interface (GUI),locating, by a user using the GUI, the main carina by viewing 2D imagesof the 3D model in an axial orientation, marking the main carina in oneof the 2D images of the 3D model, adjusting a view plane of the 3D modelaround a rotation axis defined by the marked location of the main carinato adjust the view plane from an axial orientation to a coronalorientation while keeping the main carina in the view plane to therebydisplay the entire trachea on the GUI, and marking an upper end of thetrachea in one of the 2D images of the 3D model.

According to another aspect of the present disclosure, the methodincludes importing, into an image processing computer, slice images of achest of the patient from an imaging device, generating, by a graphicsprocessor included in the image processing computer, a three-dimensional(3D) model based on the imported slice images, displaying, by the imageprocessing computer, the 3D model in a graphical user interface (GUI),marking, by a user using the GUI, the main carina in one of a pluralityof 2D images of the 3D model, adjusting, by the user using the GUI, aview plane of the 3D model to display the entire trachea on the GUI, andmarking, by a user using the GUI, an upper end of the trachea in one ofthe plurality of 2D images of the 3D model.

In a further aspect of the present disclosure, the method furtherincludes, prior to marking the main carina, locating the main carina inone of the 2D images of the 3D model.

In another aspect of the present disclosure, the user locates the maincarina by viewing the 2D images of the 3D model in an axial orientation

In yet another aspect of the present disclosure, the 3D model isgenerated based on two dimensional images obtained by tomographictechnique, radiography, tomogram produced by a computerized axialtomography scan, magnetic resonance imaging, ultrasonography, contrastimaging, fluoroscopy, nuclear scans, or positron emission tomography.

In a further aspect of the present disclosure, adjusting a view plane ofthe 3D model includes adjusting the view plane around a rotation axis.

In another aspect of the present disclosure, adjusting the view planearound the rotation axis includes adjusting the view plane from an axialorientation to a coronal orientation.

In a further aspect of the present disclosure, during the adjusting, themain carina is kept within the view plane.

In another aspect of the present disclosure, the method further includesverifying, by the user using the GUI, the marking of the trachea byreviewing a rendering of the 3D model displayed on the GUI.

In a further aspect of the present disclosure, the rendered 3D modelincludes the marking of the main carina and the marking of the upper endof the trachea.

Any of the above aspects and embodiments of the present disclosure maybe combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedherein below with references to the drawings, wherein:

FIG. 1 is a schematic diagram of an example device which may be used tomark a trachea in a 3D model of a patient's lungs, in accordance with anembodiment of the present disclosure;

FIG. 2 depicts 2D slice images generated from the 3D model showing thetrachea in the axial and coronal orientations, in accordance withembodiments of the present disclosure;

FIG. 3 is a flowchart illustrating an example method for performing anENB procedure, in accordance with an embodiment of the presentdisclosure;

FIG. 4 is a flowchart illustrating an example method for manuallymarking a trachea in a 3D model of a patient's lungs, in accordance withan embodiment of the present disclosure; and

FIG. 5 is an example view which may be presented by electromagneticnavigation pathway planning software to enable a clinician to manuallymark a trachea in a 3D model of a patient's lungs, in accordance with anembodiment of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is related to devices, systems, and methods foridentifying and manually marking a trachea and main carina on sliceimages of a patient's lungs when automatic detection of the tracheafails. Identifying the trachea may be a necessary component of pathwayplanning for performing an ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY®(ENB) procedure using an electromagnetic navigation (EMN) system.

An ENB procedure generally involves at least two phases: (1) planning apathway to a target located within, or adjacent to, the patient's lungs;and (2) navigating a probe to the target along the planned pathway.These phases are generally referred to as (1) “planning” and (2)“navigation.” Prior to the planning phase, the patient's lungs areimaged by, for example, a computed tomography (CT) scan, althoughadditional applicable methods of imaging will be known to those skilledin the art. The image data assembled during the CT scan may then bestored in, for example, the Digital Imaging and Communications inMedicine (DICOM) format, although additional applicable formats will beknown to those skilled in the art. The CT scan image data may then beloaded into a planning software application (“application”) to beprocessed for generating a 3D model which may be used during theplanning phase of the ENB procedure.

The application may use the CT scan image data to generate a 3D model ofthe patient's lungs. The 3D model may include, among other things, amodel airway tree corresponding to the actual airways of the patient'slungs, and showing the various passages, branches, and bifurcations ofthe patient's actual airway tree. While the CT scan image data may havegaps, omissions, and/or other imperfections included in the image data,the 3D model is a smooth representation of the patient's airways, withany such gaps, omissions, and/or imperfections in the CT scan image datafilled in or corrected. As described in more detail below, the 3D modelmay be viewed in various orientations. For example, if a cliniciandesires to view a particular section of the patient's airways, theclinician may view the 3D model represented in a 3D rendering and rotateand/or zoom in on the particular section of the patient's airways.Additionally, the clinician may view the 3D model represented intwo-dimensional (2D) slice images generated along the axial, sagittal,and coronal planes, and may “scroll through” such 2D slice images to a“depth” showing the particular section of the patient's airways. Theplanning phase generally involves identifying at least one target nodulein the 3D model, and generating a pathway to the target. The pathwaywill generally run from the patient's mouth, through the trachea andconnected airways, to the target. However, in order to generate thepathway to the target, the location of the trachea within the 3D modelmust be known. Generally, the application will automatically detect thetrachea within the 3D model. This process is more fully described incommonly-owned U.S. Provisional Patent Application Ser. No. 62/020,257entitled “Automatic Detection of Human Lung Trachea”, filed on Jul. 2,2014, by Markov et al., the entire contents of which are herebyincorporated by reference. However, there may be instances whereautomatic detection of the trachea fails. The present disclosure isdirected to devices, systems, and methods for manually marking thetrachea in such instances.

The trachea provides a passage way for breathing. The trachea isconnected to the larynx and the pharynx in the upper end. In particular,the upper part of the trachea extends substantially linearly from thelarynx and pharynx and behind the sternum. The lower end of the tracheabranches into a pair of smaller tubes, i.e., primary bronchi, each tubeconnecting to a lung. The main carina is a cartilaginous ridge formed bythe branching of the trachea into the primary bronchi. The diameter ofthe trachea is substantially constant along its length (i.e., the axialdirection), while the size of the lung changes substantially along thesame direction as the length of the trachea. Thus, by analyzing 2D sliceimages of the 3D model, the trachea may be detected. For this reason,images generated along the axial plane may be analyzed to detect thetrachea in the present disclosure. In other embodiments, imagesgenerated along other planes may also be used to detect the trachea.

FIG. 1 shows an image processing device 100 that may be used during theplanning phase of an ENB procedure to manually mark the location of thetrachea in the 3D model. Device 100 may be a specialized imageprocessing computer configured to perform the functions described below.Device 100 may be embodied in any form factor known to those skilled inthe art, such as, a laptop, desktop, tablet, or other similar computer.Device 100 may include, among other things, one or more processors 110,memory 120 storing, among other things, the above-referenced application122, a display 130, one or more specialized graphics processors 140, anetwork interface 150, and one or more input interfaces 160.

As noted above, 2D slice images of the 3D model may be displayed invarious orientations. As an example, FIG. 2 shows 2D slice images of the3D model of the patient's lungs in the axial and coronal orientations,with 2D slice image 210 generated along the axial plane and 2D sliceimage 220 generated along the coronal plane. Both 2D slice images 210and 220 show the trachea 212 and the main carina 214.

The 2D slice images of the 3D model may show a high density area withhigh intensity and a low density area with low intensity. For example,bones, muscles, blood vessels, or cancerous portions are displayed withhigher intensity than an inside area of airways of the lung. The 2Dslice images of the 3D model may be further processed to obtainbinarized 2D slice images, which only includes black and white pixels.The binarized 2D slice images may show white regions as non-lung areas(e.g., bones, stomach, heart, blood vessels, walls of airways, etc.) andblack regions as lung areas (e.g., the lung, the trachea, and connectedcomponents).

FIG. 3 is a flowchart illustrating an example method for performing theplanning phase of an ENB procedure, in accordance with the presentdisclosure. Starting with step S302, image data of the patient's lungsare acquired. Image data may be acquired using any effective imagingmodality, e.g., a CT scan, radiography such as an X-ray scan, tomogramproduced by a computerized axial tomography (CAT) scan, magneticresonance imaging (MRI), ultrasonography, contrast imaging, fluoroscopy,nuclear scans, and/or positron emission tomography (PET). Thereafter, atstep S304, the acquired image data is loaded into ENB planning software.The ENB planning software then, at step S306, attempts to automaticallydetect the trachea from the image data. At step S308 it is determinedwhether the trachea detection was successful. If the trachea has notsuccessfully been detected, manual detection is necessary. One method ofmanually detecting the trachea in accordance with the present disclosureis detailed below with reference to FIG. 4.

When the trachea has successfully been detected, the ENB planningsoftware enables a clinician, at step S310, to mark one or more targetlocations in the image data. Thereafter, at step S312, the ENB softwaregenerates a pathway from the trachea through the patient's airways tothe target. At step S314 it is determined whether a pathway has beengenerated for each target marked by the clinician. If not, processingreturns to step S312. If yes, the planning phase of the ENB procedure iscomplete, and, at step S316, the generated pathways may be loaded intoENB navigation software to start the navigation phase of the ENBprocedure, or stored for later use.

FIG. 4 is a flowchart of an example method for manually marking thetrachea in the 3D model by using an example view of application 122shown in FIG. 5. This example method will be processed if it isdetermined, at step S308 of FIG. 3, that the trachea detection wasunsuccessful. Application 122 may present various views of the 3D modelto assist the clinician in marking the trachea. In an embodiment, the 2Dslice images of the 3D model may be used. In other embodiments, otherviews of the 3D model may be used. Starting at step S402, a clinicianmay locate the main carina by viewing the 2D slice images of the 3Dmodel in the axial orientation, as shown in subview 510 of FIG. 5. Theclinician may have to view and “scroll through” multiple 2D slice imagesbefore finding the correct 2D slice image 511 showing the bifurcation ofthe trachea into the primary bronchi, and thus also the tip of the maincarina.

Upon finding the 2D slice image showing the tip of the main carina, theclinician, at step S404, selects the tip of the main carina to mark apoint of rotation 512. Then, at step S406, using the marked point ofrotation 512, a rotation axis is defined passing through the point ofrotation and parallel to the sagittal plane. Thereafter, at step S408,the clinician adjusts the view plane around the rotation axis, from anaxial orientation to a coronal orientation, while keeping the maincarina in the view plane, thereby exposing the length of the trachea523, as shown in subview 520 of FIG. 5. Thus, the clinician adjusts theview plane from a 2D slice image generated along the axial plane, suchas 2D slice image 210 shown in FIG. 2, to a 2D slice image generatedalong the coronal plane, such as 2D slice image 220 shown in FIG. 2. Theclinician may again have to view and “scroll through” multiple 2D sliceimages before finding a 2D slice image 521 showing the length of thetrachea 523.

Upon finding the 2D slice image showing the length of the trachea 523,the clinician, at step S410, selects the upper end of the trachea 523 tomark a second point 522. Subview 520 may then show the point of rotation512 and the second point, respectively marking the lower and upper endsof the trachea 523. Thereafter, the clinician may verify that thetrachea 523 has been correctly identified by viewing a rendering 531 ofthe 3D model of the patient's airways looking down the trachea 523 fromthe second point 522 towards the main carina, as shown by subview 530 ofFIG. 5. If, upon verification, the clinician determines at step S414that the trachea 523 has not been correctly identified, processingreturns to step S402. If the clinician determines that the trachea 523has been correctly identified, processing returns to step S308 of FIG. 3and completes the planning phase of the ENB procedure.

Returning now to FIG. 1, memory 120 includes application 122 such as EMNplanning and procedure software and other data that may be executed byprocessors 110. For example, the data may be the CT scan image datastored in the DICOM format and/or the 3D model generated based on the CTscan image data. Memory 120 may also store other related data, such asmedical records of the patient, prescriptions and/or a disease historyof the patient. Memory 120 may be one or more solid-state storagedevices, flash memory chips, mass storages, tape drives, or anycomputer-readable storage media which are connected to a processorthrough a storage controller and a communications bus. Computer readablestorage media include non-transitory, volatile and non-volatile,removable and non-removable media implemented in any method ortechnology for storage of information such as computer-readableinstructions, data structures, program modules or other data. Forexample, computer-readable storage media includes random access memory(RAM), read-only memory (ROM), erasable programmable read only memory(EPROM), electrically erasable programmable read only memory (EEPROM),flash memory or other solid state memory technology, CD-ROM, DVD orother optical storage, magnetic cassettes, magnetic tape, magnetic diskstorage or other magnetic storage devices, or any other medium which canbe used to store desired information and which can be accessed by device100.

Display 130 may be touch-sensitive and/or voice-activated, enablingdisplay 130 to serve as both an input device and an output device.Graphics processors 140 may be specialized graphics processors whichperform image-processing functions, such as processing the CT scan imagedata to generate the 3D model, and process the 3D model to generate the2D slice images of the 3D model in the various orientations as describedabove, as well as the 3D renderings of the 3D model. Graphics processors140 may further be configured to generate a graphical user interface(GUI) to be displayed on display 130. The GUI may include views showingthe 2D image slices, the 3D rendering, among other things. Inembodiments, graphics processors 140 may be specialized graphicsprocessors, such as a dedicated graphics processing unit (GPU), whichperforms only the image processing functions so that the one or moregeneral processors 110 may be available for other functions. Thespecialized GPU may be a stand-alone dedicated graphics card, or anintegrated graphics card.

Network interface 150 enables device 100 to communicate with otherdevices through a wired and/or wireless network connection. In anembodiment, device 100 may receive the CT scan image data from animaging device via a network connection. In other embodiments, device100 may receive the CT scan image data via a storage device, such as adisk or other external storage media known to those skilled in the art.

Input interface 160 is used for inputting data or control information,such as setting values, text information, and/or controlling device 100.Input interface 160 may include a keyboard, mouse, touch sensor, camera,microphone, or other data input devices or sensors used for userinteraction known to those skilled in the art.

Although the present disclosure has been described in terms of specificillustrative embodiments, it will be readily apparent to those skilledin this art that various modifications, rearrangements and substitutionsmay be made without departing from the spirit of the present disclosure.The scope of the present disclosure is defined by the claims appendedhereto.

Further aspects of image and data generation, management, andmanipulation useable in either the planning or navigation phases of anENB procedure are more fully described in commonly-owned U.S. patentapplication Ser. Nos. 13/838,805; 13/838,997; and Ser. No. 13/839,224,all entitled “Pathway Planning System and Method”, filed on Mar. 15,2013, by Baker, the entire contents of which are hereby incorporated byreference. Further aspects of the planning phase as well as thenavigation phase of an ENB procedure are more fully described incommonly-owned U.S. Provisional Patent Application Ser. No. 62/020,220entitled “Real-Time Automatic Registration Feedback”, filed on Jul. 2,2014, by Brown et al.; U.S. Provisional Patent Application Ser. No.62/020,177 entitled “Methods for Marking Biopsy Location”, filed on Jul.2, 2014, by Brown.; U.S. Provisional Patent Application Ser. No.62/020,240 entitled “System and Method for Navigating Within the Lung”,filed on Jul. 2, 2014, by Brown et al.; U.S. Provisional PatentApplication Ser. No. 62/020,238 entitled “Intelligent Display”, filed onJul. 2, 2014, by Kehat et al.; U.S. Provisional Patent Application Ser.No. 62/020,242 entitled “Unified Coordinate System for Multiple CT Scansof Patient Lungs”, filed on Jul. 2, 2014, by Greenburg.; U.S.Provisional Patent Application Ser. No. 62/020,245 entitled “AlignmentCT”, filed on Jul. 2, 2014, by Klein et al.; U.S. Provisional PatentApplication Ser. No. 62/020,250 entitled “Algorithm for FluoroscopicPose Estimation”, filed on Jul. 2, 2014, by Merlet.; U.S. ProvisionalPatent Application Ser. No. 62/020,261 entitled “System and Method forSegmentation of Lung”, filed on Jul. 2, 2014, by Markov et al.; U.S.Provisional Patent Application Ser. No. 62/020,258 entitled “Cone View—AMethod of Providing Distance and Orientation Feedback While Navigatingin 3D”, filed on Jul. 2, 2014, by Lachmanovich et al.; and U.S.Provisional Patent Application Ser. No. 62/020,262 entitled “Dynamic 3DLung Map View for Tool Navigation Inside the Lung”, filed on Jul. 2,2014, by Weingarten et al., the entire contents of all of which arehereby incorporated by reference.

Although embodiments have been described in detail with reference to theaccompanying drawings for the purpose of illustration and description,it is to be understood that the inventive processes and apparatus arenot to be construed as limited thereby. It will be apparent to those ofordinary skill in the art that various modifications to the foregoingembodiments may be made without departing from the scope of thedisclosure.

1-10. (canceled)
 11. A non-transitory computer-readable storage mediumstoring instructions for marking a trachea of a patient, theinstructions, when executed by a processor, cause a computing device to:receive, via a graphical user interface (GUI), a first mark of a maincarina in one of a plurality of two-dimensional (2D) images of a chestof a patient; adjust a view plane of a three-dimensional (3D) modelaround a rotation axis defined by the first mark; and receive a secondmark of an upper end of the trachea in one of the plurality of 2D imagesof the 3D model.
 12. The non-transitory computer-readable storage mediumaccording to claim 11, wherein the 3D model is based on the plurality of2D images.
 13. The non-transitory computer-readable storage mediumaccording to claim 11, wherein the rotation axis is parallel to asagittal plane.
 14. The non-transitory computer-readable storage mediumaccording to claim 11, wherein adjusting of the view plane of the 3Dmodel around the rotation axis is from an axial orientation to a coronalorientation while keeping the main carina in the view plane.
 15. Thenon-transitory computer-readable storage medium according to claim 14,wherein adjusting of the view plane of the 3D model to the coronalorientation while keeping the main carina in the view plane causes theentire trachea in the GUI to be displayed.
 16. The non-transitorycomputer-readable storage medium according to claim 14, wherein theinstructions, when executed by the processor, further cause thecomputing device to, prior to marking the main carina, locate the maincarina in one of the 2D images of the 3D model.
 17. The non-transitorycomputer-readable storage medium according to claim 16, wherein the maincarina is located based on input received from the user viewing the 2Dimages of the 3D model in the axial orientation.
 18. The non-transitorycomputer-readable storage medium according to claim 11, wherein the 2Dimages are obtained by computed tomography, radiography, tomogramproduced by a computerized axial tomography scan, magnetic resonanceimaging, ultrasonography, contrast imaging, fluoroscopy, nuclear scans,or positron emission tomography.
 19. The non-transitorycomputer-readable storage medium according to claim 11, wherein theinstructions, when executed by the processor, further cause thecomputing device to verify the marking of the trachea by reviewing arendering of the 3D model displayed on the GUI.
 20. The non-transitorycomputer-readable storage medium according to claim 19, wherein therendered 3D model includes the marking of the main carina and themarking of the upper end of the trachea.